NEW YORK -- The iconic couch remains an effective part of the psychoanalytic process, researchers asserted here.

Action Points

Explain to interested patients that a small analysis of archival data found that lying on a couch produced different patient-therapist interactions compared with sitting up.

Note that this study was published as an abstract and presented as a poster at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

NEW YORK, Jan. 20 -- The iconic couch remains an effective part of the psychoanalytic process, researchers asserted here.

A two-patient case report, derived from archival data, found that the use of a couch during therapy is associated with changes in the patient-therapist interaction, Ira Lable, M.D., of Harvard, said during a poster session at the American Psychoanalytic Association meeting.

The two psychoanalyses were conducted with the each patient lying down and sitting up in different phases of treatment.

Dr. Lable said the couch affects the psychoanalytic process "in a positive way," and "deepens communication between the analyst and patient."

There is much debate in psychoanalysis about the place of the couch in theory and technique. Some say it is essential to the psychoanalytic process, while others believe it is merely peripheral.

Freud's "rigid" view of the role of the couch in psychoanalysis was that it fostered "regression," or adopting a childlike mentality, and it removed the therapist from the patients' experience, making them more open, Dr. Lable said.

However, there has been little empirical research done on the use of the couch in psychoanalysis.

So the researchers analyzed two case studies in which the patients were both lying down and sitting up during therapy. They evaluated the nature of the therapeutic interaction between patient and practitioner via the Psychotherapy Process Q-Set (PQS).

In both cases, there was a "slight difference in favor of greater analytic process when lying down," though the difference was not statistically significant.

For each patient, there were certain items on the PQS that showed statistically significant differences between lying down and sitting up, with effect sizes ranging from 0.76 to 1.60 and 1.16 to 1.50, respectively. In the behavioral sciences, effect sizes larger than 0.80 are considered large.

"[The couch] can free patients from social interaction," Dr. Lable said, noting that some patients may feel more comfortable not looking at the analyst.

"When it works well, [using a couch during psychoanalysis] deepens communication between the analyst and patient, because the analyst can listen very carefully and remain impassive," he said. "And the patient comes to know that your silence is generated from empathy."

Dr. Label said future research should focus on assessing whether the couch's effects are universal, or whether they affect each patient-therapist "dyad" differently.

The researchers reported no conflicts of interest.

Reviewed by Zalman S. Agus, MD Emeritus Professor University of Pennsylvania School of Medicine